Child's Name (required)

Child's Grade (required)

PARENT/LEGAL GUARDIAN(S)

Father/Guardian 1

Mother/Guardian 2

Address


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Email Address

CONTACT NUMBERS

Father/Guardian 1
Home Phone
Cell Phone

Mother/Guardian 2

Home Phone
Cell Phone

Allergies (drugs/food)

Chronic Illnesses/Conditions

Regular Medications

I give my permission for my child to attend Mission Ignition with Riverview Baptist Church Childhood Ministries on March 2, 2019 at First Baptist Church Tulsa. I understand that every precaution will be taken to ensure safety while traveling and while in the care of RBC leaders. However, in case of emergency, I will not hold adult sponsors or the church responsible. I give my permission for emergency medical and surgical treatment of my child as may be needed in the judgment of the treating physician at the nearest clinic or hospital available. I expect to be contacted as soon as possible.
INITIAL Date